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Colour Doppler ultrasound flow patterns in the portal venous system

Department of Internal Medicine, Philipps-University, Baldingerstraße, 35043 Marburg, Germany

View larger version (72K): [in a new window]   Figure 1. Doppler ultrasound of the portal vein with a continuous hepatopetal flow in a healthy adult.

View larger version (51K): [in a new window]   Figure 2. Doppler ultrasound of the portal vein with minimal pulsatile modulation of the portal flow in a healthy adult.

View larger version (40K): [in a new window]   Figure 3. Doppler ultrasound of the portal vein with marked pulsatile modulation of the portal flow in a thin, healthy adult.

View larger version (27K): [in a new window]   Figure 4. Colour Doppler ultrasound of the hepatic vein and portal vein in a patient with heart failure, New York Heart Association Calss III and tricuspid regurgitation (left), having a triphasic flow in the hepatic vein (middle) and a marked pulsatile flow of the portal vein (right).

View larger version (30K): [in a new window]   Figure 5. Colour Doppler ultrasound in a patient with constrictive pericarditis (arrows) (left). A triphasic flow is seen in the hepatic vein (middle) and pulsatile flow in the portal vein (right). RV, right ventricle.

View larger version (33K): [in a new window]   Figure 6. Colour Doppler ultrasound of the hepatic vein and portal vein in a patient with mediastinal haematoma. A triphasic flow is seen in the hepatic vein (left) and a pulsatile flow with a reversed component of the portal vein (right).

View larger version (48K): [in a new window]   Figure 7. Colour Doppler ultrasound in a patient with pericardial effusion (left), and triphasic flow in the liver vein (middle) and pulsatile flow in the portal vein (right).

View larger version (40K): [in a new window]   Figure 8. Colour Doppler ultrasound in a patient with primary cardial lymphoma with a tumour in the right atrium (left), triphasic flow in the hepatic vein (middle) and pulsatile flow in the portal vein (right).

View larger version (41K): [in a new window]   Figure 9. Colour Doppler ultrasound of the hepatic vein (LV) and portal vein (VP) in a patient with liver cirrhosis having a monophasic flow in the hepatic vein (left) and a marked pulsatile flow of the portal vein (right).

View larger version (36K): [in a new window]   Figure 10. Colour Doppler ultrasound of the portal vein (left and middle) in a patient with heart failure, New York Heart Association Calss III, having a marked pulsatile flow with reversed flow during deep inspiration (arrows) (right).

View larger version (38K): [in a new window]   Figure 11. Doppler ultrasound in a patient with a pericardial effusion (PE) (left) and a pulsatile flow in the portal vein with a short reversed flow during deep inspiration (arrow) (right). RV, right ventricle; LV, left ventricle.

View larger version (38K): [in a new window]   Figure 12. Colour Doppler ultrasound of the splenic vein (left and middle) in a patient with liver cirrhosis, oesophageal varices and ascites. Arrows indicate flow direction. A marked pulsatile flow was seen in the portal venous system with reversed flow in the hilar splenic vein during deep inspiration (arrow, right).

View larger version (43K): [in a new window]   Figure 13. Colour Doppler ultrasound of the portal vein (left and middle) in a patient 1 week post-gastrectomy. Arrows indicate flow direction. During normal inspiration (arrow A) a breath dependent reversed flow was seen (right).

View larger version (105K): [in a new window]   Figure 14. (a) Colour Doppler ultrasound of the portal venous system in a patient with alcoholic fatty liver cirrhosis and continuous hepatofugal flow in the portal vein (the arrows indicate flow direction). (b) The same patient had hepatofugal flow in the mesenteric vein (left) and regular hepatopetal flow in the splenic vein (right). Arrows indicate flow direction.

View larger version (18K): [in a new window]   Figure 15. Four different haemodynamic flow patterns of continuous flow in the portal vein, the splenic vein and the mesenteric vein (Gaiani S, et al. 1991 [14]). (a) Isolated reversed flow in the mesenteric vein. (b) Isolated reversed flow in the splenic vein. (c) Reversed flow in the portal vein and the splenic vein. (d) Reversed flow in the portal vein and the mesenteric vein.

View larger version (100K): [in a new window]   Figure 16. (a) Colour Doppler ultrasound of the portal venous system in a patient with liver cirrhosis and continuous hepatofugal flow in the portal vein (left) and hepatopetal flow in the mesenteric vein (VMS) (right). Arrows indicate flow direction. (b) The same patient had reversed flow in the splenic vein (left). The splenic vein (VL) drained into a large perirenal collateral. Arrows indicate flow direction.

View larger version (57K): [in a new window]   Figure 17. Colour Doppler ultrasound of the portal vein in a patient with liver cirrhosis and a transjugular intrahepatic portosystemic shunt (TIPS) (left). In the umbilical segment of the portal vein a reversed flow was seen (right). Arrows indicate flow direction.

View larger version (33K): [in a new window]   Figure 18. Colour Doppler ultrasound of the portal vein in a patient with breast cancer, diffuse metastative disease of the liver and occlusion of the hepa-tic veins (Budd-Chiari syndrome) (arrows left). In the portal vein a reversed flow was seen (middle, right). Arrows indicate flow direction. VC, vena cava.

View larger version (47K): [in a new window]   Figure 19. Colour Doppler ultrasound in a patient with cavernous transformation of the portal vein (left) having reversed flow in the splenic vein (middle) and a large perisplenic collateral (right). Arrows indicate flow direction. P, pancreas; Co, confluens.

View larger version (73K): [in a new window]   Figure 20. Colour Doppler ultrasound in a patient with liver cirrhosis and portal hypertension and reversed flow in the left gastric vein (VCV). VP, portal vein.

View larger version (44K): [in a new window]   Figure 21. Colour Doppler ultrasound of the spleen in a patient with liver cirrhosis. Trans-splenic vessels were seen (middle) with a hepatofugal venous flow (right). Arrows indicate flow direction.

View larger version (38K): [in a new window]   Figure 22. Colour Doppler ultrasound of the portal vein in a patient with fatty liver cirrhosis and a "0" flow in the portal vein (VP).

View larger version (41K): [in a new window]   Figure 23. Colour Doppler ultrasound in a patient with alcoholic fatty liver cirrhosis with a hepatopetal flow during expiration (left) an a venous "0" flow in the portal vein during inspiration (right).